Motivational interviewing for substance use reduction

Probably not a substantial claim: may not pass S3 (load-bearing).

The Lindson 2019 review on motivational interviewing for smoking cessation included 12 trials and 4157 participants.

“The Lindson 2019 review on motivational interviewing for smoking cessation included 12 trials and 4157 participants.”

• cites Lindson 2019 sourceDisputed

  The paper’s Main results report 51 trials with 22,509 participants, not 12 trials with 4,157 participants. Its Discussion identifies the review’s focus as smoking reduction before quitting, not motivational interviewing. (LLM, conf=0.95)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

As in our review, most studies in Lindson 2019 reported that motivational interviewing techniques were used but did not describe the content in detail.

“As in our review, the authors note that most studies reported that motivational interviewing techniques were used but did not describe the content in detail.”

• cites Lindson 2019 sourcePartly supported

  The Discussion (page unavailable) says studies typically gave only limited explanations of intervention content. The Results identify motivational interviewing in Cook 2016, but the passages do not say that most included studies used motivational interviewing techniques. The claim applies the review’s general observation about limited detail specifically to motivational interviewing in most studies, which the cited passages do not establish. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

The effects of the intervention may have been overestimated because participants were not blinded and substance use was self-reported.

“There is also the possibility that the effects of the intervention were overestimated because participants were not blinded (Hrobjartsson 2014), and substance use was self-reported.”

• cites Hrobjartsson 2014 sourceSupported

• AssumptionRests on an assumption: Substance use outcomes in the included studies were self-reported.

May combine two claims.

The Klimas 2018 review examined several psychosocial interventions for alcohol use, including motivational interviewing, and found no difference between interventions.

“The Klimas 2018 review examined several psychosocial interventions for alcohol use, including motivational interviewing, and found no difference between interventions.”

• cites Klimas 2018 sourcePartly supported

  The Discussion (Summary of main results) says the review assessed eight psychosocial interventions, including motivational interviewing, and found no significant alcohol-use differences in most comparisons. But it reports an exception: brief motivational interviewing was associated with a greater reduction in drinking days than assessment-only. The Key results also note a possible benefit of intensive over standard motivational interviewing among women, so the unqualified claim of no difference between interventions overstates the findings. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

May combine two claims.

Klimas 2018 included only two studies, which used different scales to assess alcohol use.

“However, Klimas 2018 included only two studies, which used different scales to assess alcohol use.”

• cites Klimas 2018 sourcePartly supported

  The Included studies section says the 2018 review included seven studies, not two. The Selective reporting section says the included studies used different questionnaires to measure their outcomes, supporting the point about differing measures. Page numbers were not available in our copy. (LLM, conf=0.92)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

In most included studies (30), one motivational interviewing session was conducted.

“In most studies (30), one motivational interviewing session was conducted.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The largest included study involved 1726 people and the smallest involved 25 people.

“The largest study involved 1726 people and the smallest involved 25 people.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most included studies were conducted in the USA (72).

“The studies were conducted in countries around the world; most were in the USA (72).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Session durations varied from 10 to 148 minutes per session.

“Session durations varied, from as little as 10 minutes to as long as 148 minutes per session.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Some included studies conducted up to 9 motivational interviewing sessions.

“There were also studies in which more sessions were conducted, up to 9 sessions.”

May combine two claims.

This review includes 91 RCTs and two quasi-RCTs.

“This review includes 91 RCTs, and two quasi-RCTs (Bazargan-Hejazi 2005; Freyer-Adam 2008).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The sample sizes ranged from 25 to 1726.

“The sample sizes ranged from 25 (Kavanagh 2004) to 1726 (MATCH 1993).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Three studies focused on cocaine.

“three studies focused on cocaine”

Probably not a substantial claim: may not pass S3 (load-bearing).

Motivational interviewing was compared with no intervention in 34 studies.

“Motivational interviewing was compared with: no intervention in 34 studies”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the 93 included studies, 72 were published in the USA, five in Australia, four in the United Kingdom, four in the Netherlands, and two in Canada.

“Of the 93 included studies, 72 were published in the USA, five in Australia, four in the United Kingdom, four in the Netherlands and two studies in Canada.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For the remaining six studies, data were not reported as an effect size and it was not possible to calculate one.

“For the remaining six studies (Field 2010;Parsons 2009;Rohsenow 2004;Stotts 2001;Swogger 2016;Thush 2009), data were not reported in the form of an effect size, and it was not possible to calculate one”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Seventy-three studies were single-site RCTs and 20 were multisite RCTs.

“Seventy-three studies were single-site RCTs and 20 were multisite RCTs.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 70 studies, the intervention was motivational interviewing.

“In 70 studies, the intervention was motivational interviewing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the 93 included studies, outcome data were extracted from 87.

“Of the 93 included studies, we were able to extract outcome data from 87.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A total of 168 studies were excluded during full-text review: 85 in the previous version and 83 in the updated version.

“We excluded a total of 168 studies during full-text review: 85 studies in the previous version of the review plus 83 studiesin the updated version.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Twelve studies examined adolescents.

“12 studies examined adolescents”

Probably not a substantial claim: may not pass S3 (load-bearing).

Motivational interviewing was compared with treatment as usual in 23 studies.

“treatment as usual in 23 studies”

Probably not a substantial claim: may not pass S3 (load-bearing).

The duration of the intervention ranged from 10 to 148 minutes per session.

“The duration of the intervention ranged from 10 to 148 minutes per session”

Probably not a substantial claim: may not pass S3 (load-bearing).

Five studies included only men.

“Five studies included only men (Gaume 2014; Morgenstern 2009; Murphy 2018; Parsons 2009; Stotts 2006)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Eleven ongoing studies were identified.

“We identified 11 ongoing studies”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Ninety studies reported one comparison and three studies reported two comparisons relevant to the review.

“Ninety studies reported one comparison and three studies reported two comparisons that were relevant to us.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One study each was published in Germany, Mexico, New Zealand, South Africa, Sweden, and Switzerland.

“One study each was published in Germany, Mexico, New Zealand, South Africa, Sweden, and Switzerland.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Motivational interviewing was compared with assessment and feedback in nine studies.

“assessment and feedback in nine studies”

Probably not a substantial claim: may not pass S3 (load-bearing).

Eight studies included both adolescents and young adults.

“eight studies included both adolescents and young adults”

Probably not a substantial claim: may not pass S3 (load-bearing).

Motivational interviewing was compared with another active intervention in 30 studies.

“another active intervention in 30 studies”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Alcohol use was addressed in 43 studies, and both alcohol and other drug use in 32 studies.

“Alcohol use was addressed in 43 studies, and both alcohol and other drug use in 32 studies.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Four studies included only women.

“four included only women (Kelly 2000; Martino 2018; Stein 2010; Winhusen 2008).”

May combine two claims.

The updated review includes 93 studies with 22,776 participants, including 34 new studies published between 2010 and 2022 that examined 9178 participants.

“We included 93 studies with 22,776 participants in this updated review, including 34 new studies published between 2010 and 2022 that examined 9178 participants.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fifty-four of the studies involved adults.

“Fi yfour of the studies involved adults”

Probably not a substantial claim: may not pass S3 (load-bearing).

Five studies included multiple drugs.

“five studies included multiple drugs”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most studies included both men and women (84 studies).

“Most studies included both men and women ( 84 studies).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Ten studies focused on the use of cannabis.

“Ten studies focused on the use of cannabis”

Probably not a substantial claim: may not pass S3 (load-bearing).

Nineteen studies examined only young adults.

“another 19 studies examined only young adults”

Probably not a substantial claim: may not pass S3 (load-bearing).

Forty-one studies were listed as awaiting classification.

“we listed 41 studies as awaiting classification”

Probably not a substantial claim: may not pass S3 (load-bearing).

The remaining 23 publications referred to motivational enhancement therapy.

“The remaining 23 publications referred to motivational enhancement therapy.”

May combine two claims.

For the other three comparisons, funnel plots appear symmetrical, indicative of no publication bias, although it cannot be ruled out.

“For the other three comparisons (motivational interviewing versus: treatment as usual; assessment and feedback; and other active treatment), the funnel plots appear to be symmetrical, which is indicative of no publication bias, although it cannot be ruled out.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The number of intervention sessions ranged from one to nine, with one-third of studies (30) involving only one session.

“The number of intervention sessions ranged from one to nine sessions, with one-third of studies (30) involving only one session.”

May combine two claims.

Our analyses revealed small effect differences for comparisons of motivational interviewing to no intervention and to assessment and feedback.

“Our analyses revealed small effect differences for comparisons of motivational interviewing to no intervention and to assessment and feedback.”

May combine two claims.

Our analyses showed no differences between motivational interviewing and treatment as usual and another active intervention.

“Our analyses showed no differences between motivational interviewing and treatment as usual and another active intervention.”

May combine two claims.

The evidence was mostly of low or very low certainty; only in three comparisons was the certainty of evidence rated moderate.

“Summary of findings tables 1 to 4 (Summary of findings 1, Summary of findings 2, Summary of findings 3, Summary of findings 4) summarise the results and show that the evidence was mostly of low or very low certainty.Only in three comparisons did we rate the certainty of the evidence as moderate.”

May combine two claims.

The studies included in our review come predominantly from high-income countries, with a lack of representation from middle- and low-income countries.

“The studies included in our review come predominantly from high-income countries, with a lack of representation from middle-and low-income countries.”

May combine two claims.

We have moderate to no confidence in the evidence, so we need to be cautious about our conclusions.

“We have moderate to no confidence in the evidence, so we need to be cautious about our conclusions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the previous version of the review, the effect of motivational interviewing versus no intervention on substance use was moderate.

“while the effect of MI vs. no intervention was moderate in the last version”

May combine two claims.

In the updated review, the effect of motivational interviewing versus no intervention on substance use is small, with low certainty of evidence.

“results in the updated version show a small effect, with low certainty of evidence in both versions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The updated search in November 2022 included 34 new studies in this version of the review.

“We updated the searches in November 2022 and 34 new studies were included in this version.”

Classified as probably not a substantial claim.

Included studies did not report the secondary outcome of repeat convictions.

“Because studies did not report the secondary outcome of repeat convictions, we did not include this end point in our analyses.”

Classified as probably not a substantial claim. May combine two claims.

The certainty of the research forces the authors to be careful about their conclusions, and new research may change them.

“The certainty of the research forces us to be careful about our conclusions; new research may change them.”

May combine two claims.

Some of the previous systematic reviews studied the effects of motivational interviewing on groups besides those who use substances, or studied only people who drink alcohol.

“Some of these have studied the effects of motivational interviewing on groups besides those who use substances, or have studied only people who drink alcohol.”

May combine two claims.

Thirty studies were judged high risk for incomplete outcome data because losses to follow-up exceeded 20%, reasons were not described, and no intention-to-treat analysis was reported.

“For 30 studies, we judged the risk of bias as high because losses to follow-up were higher than 20%, the reasons for losses were not described, and no intention-to-treat (ITT) analysis was reported.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Review authors were not blinded to the names of the study authors, institutions, or journal of publication.

“Review authors were not blinded to the names of the study authors, institutions, or journal of publication.”

Classified as probably not a substantial claim. May combine two claims.

The analyses were based on the intention-to-treat principle; all participants who were randomised were included in the statistical analysis and analysed according to the originally assigned group, regardless of which treatment they received.

“Our analyses were based on the intention-to-treat principle; that is, all participants who were randomised were included in the statistical analysis and analysed according to the originally assigned group, regardless of which treatment (if any) they received.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Motivational interviewing is regarded as a 'fluid' intervention, which has led to mixed results regarding evidence.

“Thus, it is regarded as a 'fluid' intervention, which has led to mixed results regarding evidence (Björk 2014;Miller 2014).”

• cites Björk 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Miller 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two review authors independently screened titles, abstracts, and full texts, with disagreements resolved through discussion or by a third review author.

“At stage one, working independently, two review authors scanned the titles of each reference.”

• Also stated in: § Selection of studies · plain

  “At stage two, working independently, two review authors read the titles and abstracts, and applied the same promotion rules.”

• Also stated in: § Selection of studies · plain

  “Working independently, two review authors read the full texts and scored each as 'include' or 'exclude'.”

May combine two claims.

For substance use, access to and availability of substances, as well as patterns of use, are changing.

“For substance use in particular, access to and availability of substances, as well as patterns of use, are changing (UNODC 2022).”

• cites UNODC 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

The main strengths of this review are its exhaustive and systematic search strategy, restriction to randomised controlled trials, assessment of the included studies' risk of bias, and GRADE assessments of evidence for the primary outcomes.

“The main strengths of this review are its exhaustive and systematic search strategy, restriction to randomised controlled trials, assessment of the included studies' risk of bias, and GRADE assessments of evidence for the primary outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Where an adequate number of studies were available (more than 10 studies), the review created funnel plots to assess small-study effects and to explore the possibility of publication bias.

“Where an adequate number of studies were available (more than 10 studies), we created funnel plots to assess small-study effects and to explore the possibility of publication bias.”

• AssumptionRests on an assumption: Publication bias poses a significant threat to the validity of any systematic review.

Probably not a substantial claim: may not pass S3 (load-bearing).

Thirty-four studies were assessed as unclear risk for sequence generation because they did not describe the method.

“We assessed 34 studies as unclear risk as they did not describe the sequence generation method”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

For the review update, title and abstract screening was independently performed by RS, CD, SU, and SH in two teams of two, using Rayyan.

“For this review update, title and abstract screening was independently performed by RS, CD, SU, and SH (two teams of two), using Rayyan (Ouzzani 2016).”

• cites Ouzzani 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Three studies were assessed as high risk for sequence generation because they did not use adequate methods.

“three studies as high risk because they did not use adequate methods to generate a random allocation.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2014, Miller and Rollnick described three quality conditions related to intervention content, quality assurance, and intervention fidelity that should be present in a study.

“As a result, in 2014, they described three quality conditions -related to intervention content, quality assurance, and intervention fidelity -that should be present in a study.”

• cites Miller 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Miller and Rollnick suggested that therapists should be trained on an appropriate predefined performance criterion prior to treating study participants.

“(2) therapists should be trained on an appropriate predefined performance criterion prior to treating study participants;”

• cites Miller 2014 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The review assessed the certainty of the evidence using the GRADE approach for extent of substance use at four follow-up periods, readiness to change, and retention in treatment.

“We assessed the certainty of the evidence using the GRADE approach for the following outcomes: extent of substance use at four follow-up periods (post-intervention, short-, medium-, and long-term follow-up), readiness to change, and retention in treatment.”

Classified as probably not a substantial claim.

The review conducted sensitivity analyses to assess the robustness of the results of the primary outcome by removing studies with a high or unclear risk of bias and including only studies with a low risk of bias.

“We conducted sensitivity analyses to assess the robustness of the results of our primary outcome by removing studies with a high or unclear risk of bias and including only studies with a low risk of bias.”

May combine two claims.

For SMDs of 0.5 (medium) and 0.8 (large), the optimal information size is 290 and 116, respectively.

“For SMDs of 0.5 (medium) and 0.8 (large), the OIS is 290 and 116, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Patterns of health, disease, and mortality are dynamic and change at both individual and population levels.

“First, patterns of health, disease, and mortality are dynamic and change at both individual and population levels (Cockerham 2021).”

• cites Cockerham 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Miller and Rollnick expressed concerns regarding treatment implementation and fidelity.

“Although Miller and Rollnick embraced this fluidity and indeed encouraged the flexible use of motivational interviewing, they expressed concerns regarding treatment implementation and fidelity.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

At stage three, full-text review of retrieved articles was independently performed by RS, CD, SU, and SH in two teams of two, using Covidence.

“At stage three, fulltext review of retrieved articles was independently performed by RS, CD, SU, and SH (two teams of two) in Covidence (Covidence 2022).”

• cites Covidence 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Miller and Rollnick suggested that the intervention should include the components that are theoretically and empirically related to its effectiveness.

“Specifically, they suggested that: (1) the intervention should include the components that are theoretically and empirically related to its effectiveness;”

• cites Miller 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Seventeen studies were judged unclear risk for attrition bias because authors stated they used an intention-to-treat analysis but did not report it.

“We judged the risk of attrition bias as unclear for 17 studies because study authors stated they used an ITT analysis but did not report this.”

May combine two claims.

In 41 studies, assessors appeared adequately blinded or results were validated by physiological data, and these were assessed as low risk.

“In a total of 41 studies, the assessors appeared to be adequately blinded or the results were validated by physiological data; we thus assessed these as having a low risk in this domain.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Twenty-one studies were classified as unclear risk for selective reporting.

“We classified the risk of bias as unclear for 21 studies”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review used the optimal information size to assess whether the sample size was sufficient to derive a statistically significant effect in a meta-analysis.

“We used the optimal information size (OIS) (Pogue 1997) to assess whether the sample size was sufficient to derive a statistically significant effect in a meta-analysis.”

• cites Pogue 1997 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Miller and Rollnick suggested that intervention fidelity should be thoroughly documented through reliable coding of therapeutic sessions throughout the study and reported in a manner that allows for direct comparison with competency levels reported in other studies.

“(3) intervention fidelity should be thoroughly documented through reliable coding of therapeutic sessions throughout the study and reported in a manner that allows for direct comparison with competency levels reported in other studies (Miller 2014).”

• cites Miller 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two review authors independently performed data extraction in Covidence using a data extraction form.

“Working independently, two review authors performed data extraction in Covidence (Covidence 2022), using a data extraction form that contained the following information:”

• cites Covidence 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Twenty-four studies were classified as low risk for other potential sources of bias.

“We classified 24 studies as low risk of bias”

Probably not a substantial claim: may not pass S3 (load-bearing).

Fifty-four studies were classified as unclear risk for other sources of bias.

“We classified 54 studies as having an unclear risk of other sources of bias”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two authors independently extracted the data for each study, and a third author compared the extraction forms.

“Two authors independently extracted the data for each study; a third author then compared the extraction forms.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Working independently in two teams of two, the review authors assessed risk of bias using version one of the Cochrane risk of bias tool.

“Working independently in two teams of two, we assessed risk of bias using version one of the Cochrane risk of bias tool (Higgins 2017).”

• cites Higgins 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

None of the review authors had a personal, scientific, or financial conflict of interest or expected to profit from the results, thereby reducing the risk of confirmation and significance bias.

“None of the review authors had a personal, scientific, or financial conflict of interest or expected to profit from the results in the form of reviewer decisions or fundraising, thereby reducing the risk of confirmation and significance bias.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Clinical heterogeneity could be due to the populations included, which differed in terms of age, type and severity of substance use, and the substances consumed.

“Clinical heterogeneity could be due to the populations included, which differed in terms of age, type and severity of substance use, and the substances consumed.”

May combine two claims.

The certainty for motivational interviewing versus other active intervention was downgraded by one level because randomisation was unclearly reported and there was a high risk of bias in most studies.

“We downgraded by one level because randomisation was unclearly reported and there was a high risk of bias in most studies.”

Classified as probably not a substantial claim. May combine two claims.

To reduce the risk of bias in the review process, two authors independently screened titles and abstracts, read full texts, extracted data, and assessed risk of bias in the included studies.

“To reduce the risk of bias in the review process, two authors independently screened the titles and abstracts, read the full texts, extracted data, and assessed the risk of bias in the included studies.”

May combine two claims.

Heterogeneity might result in inconsistency and imprecision of the treatment effect when the confidence interval includes very different effects and the total number of participants was lower than the optimal information size.

“This might result in inconsistency and imprecision of the treatment effect, when the confidence interval includes very different effects and the total number of participants was lower than the optimal information size.”

May combine two claims.

Evidence was downgraded when the randomisation procedure was not described in detail or when attrition bias was unclear or high, which was the case in many studies.

“We downgraded evidence when the randomisation procedure was not described in detail or when attrition bias was unclear or high, which was the case in many studies.”

Classified as probably not a substantial claim.

The evidence was downgraded in cases of moderate or substantial unexplained heterogeneity between the treatment effects of different studies.

“We downgraded in cases of moderate or substantial unexplained heterogeneity between the treatment effects of different studies.”

May combine two claims.

Subgroup analysis showed that the difference in effect estimates was slightly higher when the substance was alcohol or fewer sessions were conducted, and the effect was smaller when participants used more than one substance.

“Our subgroup analysis showed that the difference in effect estimates was slightly higher when the substance was alcohol or fewer sessions were conducted.Our analysis also showed that the effect was smaller when participants used more than one substance.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Scientific journals impose strict word limits on articles, so important information about the study may not have been reported for that reason.

“Scientific journals impose strict word limits on articles, so important information about the study may not have been reported for that reason.”

May combine two claims.

The substantial heterogeneity in treatment effects when comparing motivational interviewing with no intervention showed a slightly higher benefit for motivational interviewing at post-intervention in studies of alcohol use and a slightly lower benefit in studies with more than one session, but substantial unexplained heterogeneity remained.

“The substantial heterogeneity in treatment effects when comparing motivational interviewing with no intervention showed a slightly higher benefit for motivational interviewing at the post-intervention time point in studies of alcohol use and a slightly lower benefit in studies with more than one motivational interviewing session, but there was still substantial unexplained heterogeneity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The authors contacted authors of published studies and searched ClinicalTrials.gov for unpublished studies to minimise the risk of publication bias.

“Additionally, we contacted authors of published studies and searched on ClinicalTrials.gov to search for unpublished studies to minimise the risk of publication bias.”

May combine two claims.

It is not possible to say whether the small differences found in this review were due to an actual lack of efficacy of motivational interviewing or whether motivational interviewing was not implemented as intended.

“Therefore, it is not possible to say whether the small differences found in this review were due to an actual lack of efficacy of motivational interviewing or whether motivational interviewing was not implemented as intended.”

May combine two claims.

Most studies were conducted in the USA, which is an important consideration for generalisability, as different social contexts may influence substance-use patterns and the availability and accessibility of an intervention.

“Most studies were conducted in the USA, which is an important consideration in terms of the generalisability of the results, as different social contexts may influence substance-use patterns and the availability and accessibility of an intervention.”

• AssumptionRests on an assumption: Different social contexts may influence substance-use patterns and the availability and accessibility of an intervention.

Probably not a substantial claim: may not pass S3 (load-bearing).

The methodological quality of a study does not necessarily correspond to the quality of reporting of the study.

“The methodological quality of a study does not necessarily correspond to the quality of the reporting of the study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Alderson 2020, allocation was concealed by central allocation using a secure web-based system, giving low risk of selection bias.

“Central allocation using a secure web-based system.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Bell 2007, blinding of patients and providers was at high risk of performance and detection bias because there was no blinding.

“Blinding (performance bias and detection bias) Patients and providers High risk No blinding of participants and providers.”

May combine two claims.

In Aharonovich 2017, assessors were not blinded because drug use was self-assessed in interviews, giving high risk of detection bias.

“Self-assessment of drug use, assessed in interviews.”

May combine two claims.

In Alderson 2020, assessors were not blinded because self-reported substance use outcomes were assessed in questionnaires, giving high risk of detection bias.

“Self-reported outcomes on substance use were assessed in questionnaires.”

May combine two claims.

In Bell 2007, participants were assigned to condition by a computerized urn randomisation program balancing for age, education, history of head injury with loss of consciousness, gender and enrolment in standard treatments, giving low risk of bias for sequence generation.

“Participants were assigned to condition by a computerized urn randomisation program which balanced for distribution to the groups by the following factors: age, education, presence or absence of history of head injury with loss of consciousness, gender, and enrolment (yes/no) in the six standard treatments...”

May combine two claims.

Similar to our findings, the Foxcro 2016 review reported small differences in favour of motivational interviewing for quantity of alcohol consumed, frequency of alcohol consumption, and alcohol problems at follow-up of less than four months.

“Similar to our findings, the Foxcro 2016 review on motivational interviewing for the prevention of alcohol misuse in young adults reported small differences in favour of motivational interviewing for the quantity of alcohol consumed, the frequency of alcohol consumption, and alcohol problems at follow-up of less than four months.”

• cites Foxcro 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Ball 2007b, the published report included all expected outcomes based on the stated hypotheses, giving low risk of reporting bias.

“The published report included all expected outcomes based on the stated hypotheses.”

May combine two claims.

In Bell 2007, 22% were lost to follow-up at 2 months with no intention-to-treat analysis, giving high risk of attrition bias.

“22% were lost to follow-up at 2 months.No ITT analysis.”

May combine two claims.

In Ball 2007b, attrition was 32% at 8 weeks and 32% at 16 weeks after treatment, with no significant differences between therapy conditions or condition-by-site interactions in follow-up rates or missing data, giving low risk of attrition bias.

“32% attrition at 8 weeks after treatment.32% attrition at 16 weeks after treatment.”

May combine two claims.

In Aharonovich 2017, loss to follow-up was 6.7%, 12.1% and 13.3% at 60 days, 6 months and 12 months respectively, with small differences between conditions, giving low risk of attrition bias.

“6.7%, 12.1%, 13.3% loss to follow-up at 60 days, 6 months, and 12 months, respectively, with small differences between conditions.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Alderson 2020, blinding of participants and providers was not possible, giving high risk of performance/detection bias.

“Blinding not possible for participants or providers;”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Anton 2005, collateral and biological measurement were used to corroborate self-reports of substance use and there were no differences between groups at baseline, giving low risk of other bias.

“Used collateral and biological measurement to corroborate self-reports of substance use.There were no differences between groups at baseline.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Alderson 2020, all pre-planned outcomes from the protocol were reported, giving low risk of reporting bias.

“All pre-planned outcomes from the protocol were reported in the study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Foxcro 2016 found no difference or only a marginal difference for alcohol problems and binge drinking.

“However, no difference or only a marginal difference was found for alcohol problems and bingedrinking.”

• cites Foxcro 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In Ball 2007b, randomization used a computerized program involving a process of urn allocation, giving low risk of bias for sequence generation.

“The randomisation used a computerized program.(...) This program involved a process of urn allocation.”

May combine two claims.

In Bazargan-Hejazi 2005, each of the 3 health promotion advocates performed random allocation for their own enrollees, assigning the first participant by a flip of a coin and alternating thereafter, giving high risk of bias for sequence generation and allocation concealment.

“Each of the 3 health promotion advocates performed random allocation for their own enrollees, assigning the first participant by a flip of a coin, and alternating status thereafter.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

In Barnett 2007, there was no blinding, giving high risk of performance/detection bias.

“No blinding.”

May combine two claims.

In Anton 2005, although there was no blinding, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, giving low risk of performance/detection bias.

“No blinding, but most outcomes were physiological and also used to validate self-reports, and not likely to be influenced by lack of blinding.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Barnett 2007, the published report included all expected outcomes based on the stated hypotheses, giving low risk of reporting bias.

“The published report included all expected outcomes based on the stated hypotheses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Foxcro 2016 further analyses revealed no clear association between the duration of the motivational interviewing intervention and effect size.

“Further analyses revealed no clear association between the duration of the motivational interviewing intervention and the Cochrane Database of Systematic Reviews effect size.”

• cites Foxcro 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

In Bernstein 2009, selective reporting was at low risk because all expected outcomes were reported.

“Selective reporting (reporting bias) Low risk The published report included all expected outcomes based on the stated hypotheses.”

May combine two claims.

In Ball 2007b, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, giving low risk of detection bias.

“Insufficient information to know whether assessors were blinded.But most outcomes were physiological, also used to validate self-reports, and not likely to be influenced by lack of blinding.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Bernstein 2009, random sequence generation was at low risk because randomization was computer-generated in blocks stratified by age.

“Random sequence generation (selection bias) Low risk”

May combine two claims.

In Ball 2007a, although there was no blinding, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, giving low risk of performance/detection bias.

“No blinding, but most outcomes were physiological, used to validate self-reports, and not likely to be influenced by lack of blinding.”

May combine two claims.

In Bernstein 2009, incomplete outcome data was at high risk because 30% were lost at 3 months and 29% at 12 months, not balanced, reasons not stated, and no ITT analysis.

“Incomplete outcome data (attrition bias) All outcomes High risk 30% loss to follow-up at 3 months in the assessed groups, not balanced between groups.29% loss to follow-up at 12 months across all groups, not balanced across groups.Reasons for loss not stated.No ITT analysis, but worstcase scenario analysis.”

May combine two claims.

In Alderson 2020, 46.5% of participants were lost at 12 months, balanced across groups, giving high risk of attrition bias.

“46.5% loss at 12 months, balanced across groups.”

May combine two claims.

In Aharonovich 2017, participants and providers were not blinded to assignment to MI versus educational control, giving high risk of performance/detection bias.

“No blinding of participants and providers to assignment to MI versus educational control.”

May combine two claims.

In Ball 2007b, time spent in training was not balanced across conditions and some contamination of therapy conditions may have occurred, giving high risk of other bias.

“Time spent in training was not balanced across conditions.Some contamination of therapy conditions may have occurred.”

May combine two claims.

In Bazargan-Hejazi 2005, enrollees were not followed up by the same health promotion advocate who assessed them initially and patients were told not to reveal their group assignment, giving low risk of detection bias.

“To guard against interviewer bias and to ensure that health promotion advocates were blinded to the patients' randomization allocation for the 3-month follow-up assessments, enrollees were not followed up by the same health promotion advocate who assessed them initially.Patients were notified not to reveal their group assignment to any project staff at any time.”

May combine two claims.

In Aharonovich 2017, substance use at 6 and 12 months was reported incompletely, only in figures without standard deviations, giving high risk of reporting bias.

“Substance use at 6 and 12 months was reported incompletely (only in figures, without SD).”

May combine two claims.

In Ball 2007a, alcohol breath testing was used as a check of self-report, giving low risk of other bias.

“Alcohol breath testing used as check of self-report.”

May combine two claims.

In Aharonovich 2017, randomization was stratified on drug use severity, depression and unstable housing using urn randomization, giving low risk of bias for sequence generation.

“Randomization was stratified on drug use severity, depression and unstable housing using urn randomization.”

May combine two claims.

In Ball 2007a, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, and the hand-held computer assessment was unlikely to have caused bias, giving low risk of detection bias.

“Insufficient information to know whether assessors were blinded.But most outcomes were physiological, used to validate self-reports, and not likely to be influenced by lack of blinding.The non-blinding may have caused bias regarding the interviews, but the hand-held computer assessment is unlikely to have caused bias.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Foxcro and colleagues concluded that effect sizes were too small and therefore motivational interviewing has no substantial, meaningful benefit for young adults' alcohol misuse.

“Overall, Foxcro and colleagues concluded that the effect sizes were too small and, therefore, motivational interviewing has no substantial, meaningful benefit for young adults' alcohol misuse.”

• cites Foxcro 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Barnett 2007, a research assistant blind to intervention condition conducted the 3- and 12-month follow-up assessments, giving low risk of detection bias.

“A research assistant who was blind to intervention condition conducted the 3-and 12-months follow-up assessments in person, or by phone and mail (...).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Alderson 2020, a computer random generator stratified by placement type, site and age band was used, giving low risk of bias for sequence generation.

“Computer random generator, stratified by placement type (residential / nonresidential), site (local authority) and age band (12 to 14 / over 14).”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Bazargan-Hejazi 2005, the published report included all expected outcomes based on the stated hypotheses, giving low risk of reporting bias.

“The published report included all expected outcomes based on the stated hypotheses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In Bell 2007, blinding of assessors was at high risk because outcomes were self-reported.

“Blinding (performance bias and detection bias) Assessors High risk Self-reported outcomes (alone or with the help of a research assistant).”

May combine two claims.

In Bazargan-Hejazi 2005, only self-reported outcomes were used and the intervention group had a higher rate of drug use and lower mean age at baseline, giving high risk of other bias.

“Only self-reported outcomes.The intervention group had a higher rate of drug use and lower mean age at baseline.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Bazargan-Hejazi 2005, there was no blinding, giving high risk of performance/detection bias.

“No blinding.”

May combine two claims.

In Bazargan-Hejazi 2005, attrition was 37% at the 3-month follow-up, balanced between groups, with reasons explained but no intention-to-treat analysis, giving high risk of attrition bias.

“37% attrition at the 3-month follow-up, balanced between groups.Reasons for attrition explained.ITT analysis was not performed.”

May combine two claims.

In Anton 2005, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, giving low risk of detection bias despite uncertainty about assessor blinding.

“Insufficient information to know whether assessors were blinded.But most outcomes were physiological, used to validate self-reports, and not likely to be influenced by lack of blinding.”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

In Bell 2007, the published report included all expected outcomes based on the stated hypotheses, giving low risk of reporting bias.

“The published report included all expected outcomes based on the stated hypotheses.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In Barnett 2007, a random numbers table was used for sequence generation, giving low risk of bias.

“Random numbers table.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

In Bell 2007, there was no blinding, giving high risk of performance/detection bias.

“No blinding.”

May combine two claims.

In Ball 2007b, although there was no blinding, most outcomes were physiological and used to validate self-reports and were not likely to be influenced by lack of blinding, giving low risk of performance/detection bias.

“No blinding, but most outcomes were physiological, also used to validate selfreports, and not likely to be influenced by lack of blinding.”

May combine two claims.

In Aharonovich 2017, no sample size calculation was reported, contributing to high risk of other bias.

“no sample size calculation reported”

May combine two claims.

In Anton 2005, attrition was 15% at 12 weeks after treatment, balanced across conditions, with reasons addressed and an intention-to-treat analysis performed, giving low risk of attrition bias.

“15% attrition at 12 weeks after treatment.Balanced across conditions.Reasons addressed.ITT analysis performed.”

May combine two claims.

In Aharonovich 2017, there were relevant differences between groups in high-school education (> 10%), contributing to high risk of other bias.

“Relevant differences in high-school education (> 10%)”

Probably not a substantial claim: may not pass S3 (load-bearing).

In contrast to our findings, the Foxcro 2016 analysis revealed a small difference in favour of motivational interviewing for amount of alcohol consumed and frequency of alcohol consumption at follow-up of four months or longer.

“In contrast to our findings, their analysis revealed a small difference in favour of motivational interviewing for the amount of alcohol consumed and the frequency of alcohol consumption at follow-up of four months or longer.”

• cites Foxcro 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

In Bell 2007, other bias was at high risk because only self-reported outcomes were used, there were baseline differences in substance use, and 66% of MI participants did not receive the intervention.

“Other bias High risk Only self-reported outcomes.Baseline differences between intervention groups in substance use.Due to logistical challenges in delivering MI (some MItrained staff were reluctant to take part in the study), 66% of participants randomised to MI did not receive the intervention.”

May combine two claims.

In Aharonovich 2017, only self-reported outcomes were used, contributing to high risk of other bias.

“Only self-reported outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing).